Suture delivery system

ABSTRACT

A device is described. The device includes a suture guide and a tissue retracting surface to enable accurate and safe delivery of sutures through tissue.

RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 16/091,936,filed Oct. 5, 2018, which application is a 371 national phase ofPCT/EP2017/059233, filed Apr. 19, 2017, and claims the benefit under 35U.S.C. § 119(e) of U.S. Provisional Application No. 62/324,422, filedApr. 19, 2016, the disclosures of which are incorporated, in theirentirety, by this reference.

BACKGROUND

The present invention relates to a suture delivery system. In oneconfiguration it relates to a suture delivery system which operablyprovides for deployment of an anchoring or suture deployment system maybe usefully employed in surgery.

There are difficulties sometimes associated with the closure of woundsites for example, where the defect is greater than two centimeters inlength. There are difficulties in particular in finding the fascia layerthrough which a suture must be passed to ensure good and adequatefascial recruitment and there is also the risk of damaging internalstructures when deploying a suture passer. When suturing abdominalwounds a retractor is often used to open the defect and present theabdominal layers to the user making it easier to place the suturethrough the relevant layers. The device disclosed here provides forretractor functionality while enabling accurate and protected suturedeployment.

The consequences of inadequate closure may be serious. For example, thepatient may be subject to an early or late onset hernia, wounddehiscence, bowel stricture, infection, or bleeding from the defect.

SUMMARY

These needs and others are addressed in accordance with the presentteaching which provides a suture delivery system intended to enablesafer and more repeatable wound closure subsequent to a laparoscopic,single port or general surgical procedures where abdominal closure isrequired. The principle disclosed herein may be applied to a widevariety of closure scenarios.

Accordingly there is provided a device, kit and method as defined in theclaims that follow.

These and other features of the present teaching will be betterunderstood with reference to the drawings which follow which areprovided to assist in an understanding of the present teaching and arenot to be construed as limiting in any fashion.

BRIEF DESCRIPTION OF THE DRAWINGS

The present teaching will now be described with reference to theaccompanying drawings in which:

FIGS. 1A, 1B, and 2 show configurations of devices that may be providedin accordance with the present teaching.

FIGS. 3A, 3B, 3C, 3D, 3E, and 3F show shows an alternative arrangementof the device of FIG. 1 .

FIGS. 4 and 5 show multiple views of another embodiment of the device inaccordance with the present teaching.

FIG. 6 shows a section views of the device of FIGS. 4 and 5 with apreloaded anchor.

FIGS. 7A, 7B, 8A, and 8B show alternative arrangements for the reloadingor delivery of anchors through a guide channel in accordance with thepresent teaching.

FIG. 9 shows the device of 4 and 5 used to secure a prosthetic mesh.

FIGS. 10A, 10B, 10C, 10D, and 10E show multiple views of the device ofFIGS. 4 and 5 configured to deliver a loop of suture.

DETAILED DESCRIPTION

The teaching of the present invention will now be described withreference to exemplary embodiments thereof which are provided to assistwith an understanding of the present teaching and are not to beconstrued as limiting in any way. It will be appreciated thatmodifications can be made to the exemplary arrangements which followwithout departing from the spirit or scope which is only to be limitedinsofar as is deemed necessary in the light of the appended claims.

Within the context of the present teaching a suture delivery systemadvantageously allows for the delivery of suture within an abdominalcavity of the patient. It will be appreciated that the followingdiscussion regarding the specifics of the abdominal cavity and abdominalwall should not be construed as limiting in that a system provided inaccordance with the present teaching may be used with other types oftissue including but not limited to organs, bones or the like. The useof a suture delivery system per the present teaching may be used forclosure of a wound post completion of a surgical procedure. In such aconfiguration the device is used to accurately guide the suture orsuture anchor assembly, where the suture is coupled to an anchor,through the abdominal wall and is held within the wall by the anchorsthat will remain deployed within the abdominal cavity, a subsequenttightening of the sutures will cause the sides of the incision, or breakin the abdominal cavity to be brought together to close the wound. Theadoption of such a technique will advantageously require the use ofbioabsorbable anchors, as the anchors will remain within the abdominalcavity during the healing process prior to their ultimatedisintegration. For scenarios where permanent support is required,non-absorbable sutures and anchors may be used utilizing materials suchas PEEK, PE, Nylon, Stainless Steel, or Nickel Titanium alloys.

In a further embodiment the anchors may be made from a ferromagneticmaterial so that a magnet could be passed down a trocar and the anchorswould be attracted to and adhere to the magnet, allowing them to bedrawn out through the trocar. The advantage of this approach is thatdirect visualization may not be necessary. Alternatively, the anchorsmay be themselves magnets and a ferromagnetic pick up device could beemployed through the trocar to pick up the anchors.

FIG. 1A shows an example of the device 50 with a driver tool 500inserted through it. A driver tool or suture passer may be passedthrough the section of the device 300 that will be position adjacent tothe tissue requiring suturing to ensure an appropriate recruitment oftissue. A deployment channel 320 is configured with an optimal anglesuture stability post deployment. The device features a landing zone 110that cooperates with the tissue being retracted and a lip 105 thatensures tissue stability. As shown in FIG. 2 , a finger hole is 130 isprovided for controlling the device in this configuration but a handleor other interface could also be provided. A slot could also be providedin the deployment channel 320 to ease suture removal after deployment.

FIG. 1B show the device in a projected view and illustrates the positionof the suture channel entrance 310 and exit 330. The device alsofeatures a sharps protector 115 which prevents the sharp tip of thesuture passer or anchor driver from causing injury. This is anadvantageous feature as it obviates the need for internal visualizationduring deployment in laparoscopic procedures and provides additionalsafety in open surgery settings. The tip of the device 120 is configuredto be atraumatic to facilitate safe and efficient delivery.

FIG. 2A shows a defect 400 with tissue 450 either side. In the providedconfiguration the device is inserted through the defect and the grip isposition to provide good anchoring into the tissue. The driver 500 maybe inserted at this point or the tool may be rotated to retract theedges of the defect towards the visual field of the user for easierdeployment prior to driver deployment. In the configuration shown asuture anchor 600 comprised of a suture 610 and an anchor 620 isdeployed through each side of the defect enabling subsequentapproximation. The device can be repeatedly deployed in sets of two toenable longer defects to be approximated. In the scenario where a suturepasser is used the suture would be deployed through one side and thenpicked up thorough the opposite side using the retractor guide todeliver the passer in each instance.

As described above, the present teaching provides a suture deliverydevice 50 that operably may be used to deliver suture and/or anchorswithin a defect. The device 50 comprises a head portion 130, a bodyportion 140 and a foot portion 150. The device is configured such thatthe foot portion 150 is operably presented first into a defect 400 andengages with an inner surface 410 of the defect. The body portion 140comprises a suture driver guide channel 320 having an entry port 310provided on a first side of the body portion 140 and an exit port 320provided on a second side of the body portion 140. The foot portion 150defines a landing zone 110 at or proximal to the exit port within whichat least a portion of surface of the defect is operably received. Inthis way and as shown in FIG. 2 , a suture driver passing through thesuture driver guide channel 320 will exit the exit port and pass intothe surface of the defect within the landing zone. The foot includes ananchoring feature 107 which anchors the device and facilitates tissuemanipulation during use.

The foot portion comprises an inner surface 200 provided proximal to thelanding zone and an outer surface 210 arranged distally to the landingzone. The inner surface provides an abutment surface defining a limit oftravel of a suture driver passing through the suture driver guidechannel. The foot portion further comprises a blunt leading surface 220.The foot portion further defines a volume 205 having an open mouth, thelanding zone being accessed through the mouth. The volume 205 may be aclosed volume as shown in FIG. 2B or may be provided as an open volumehaving gaps or apertures provided proximal to the leading surface 120.The foot portion may further comprises a lip 105, the lip defining anengagement surface for contacting with and gripping against the innersurface of the defect. In this way, on gripping against the innersurface of the defect, at least a portion of the defect is received intothe mouth of the foot portion.

As shown in FIG. 1B, the exit port is located above the mouth and theguide channel is angularly orientated relative to the mouth of the footportion such that operably, on receipt of at least a portion of thedefect into the landing zone, a suture driver passing through the guidechannel will pass through first and second surfaces of the defect priorto contact with the abutment surface.

The body 140 comprises a shoulder region 141, the entry port 310 beingdefined in the shoulder region. Advantageously, the width of the bodyportion below the shoulder 141 is greater than the width of the bodyportion above the shoulder. In this way the length of the channel 320may be maximized to provide additional structural integrity to the pathand also ensure that the angle of attach of the driver when presentedthrough the channel is maintained. By locating the entry port 310 withinthe shoulder region it will also be appreciated that visualization ofpresentation of the driver 500 is facilitated.

The guide channel in this arrangement is desirably orientated at anangle in the range 20 to 45 degrees relative to a vertical axis of thebody. More typically, the present inventor has found that by providingthe guide channel within the body so as to be orientated at an angle ofabout 30 degrees relative to a vertical axis of the body that it iseasier to ensure accurate presentation of suture—with anchor asappropriate—to a particular portion of the defect as shown in FIG. 2 .

The guide channel is typically positioned at a desirable distance(within the range 5 to 10 mm has been found optimum) relative to an edgeof the device to enable repeatable spacing between sets of deployedsutures along the length of a defect.

As was described above the device is arranged such that the foot portionis operably presented first into a defect and engages with the defect.The device is arranged such that it will contact with both the side wall415 of the defect and the inner surface 410 of the abdominal wall. Bycontacting the abdominal wall in two planes, and receiving tissue into atissue receiving portion defined in the device between the twocontacting surfaces, the present teaching advantageously ensures thatthe suture driver 500 when passing through the suture driver guidechannel 320 will exit the exit port 330 and pass into the surface of thedefect within the landing zone. The surface within which the exit portis defined is a second surface of the guide device and as shown in FIG.2 operably abuts against the side wall of the defect. The foot portiondefines a contact surface 105 that operably abuts against the innersurface of the abdominal wall such the second surface is substantiallyperpendicular to the foot portion contact surface.

While not shown in the Figures, the device may be configured such thatthe body comprises an access channel or slot along the length of theguide channel. The purpose of the slot is to facilitate extraction ofsuture that has been passed through the guide channel and is locatedwithin the defect without requiring a removal of the device from thedefect. So as to restrict the escape from the guide channel of otherdeliverable elements, the slot has a diameter smaller than the diameterof the guide channel. Typically the diameter of the slot is about 0.5 to1.5 mm.

As shown in the Figures, the device head portion 130 provides a contactsurface to user engagement to facilitate a location of the device withinthe defect. In this exemplary arrangement, the head portion is offsetfrom a longitudinal axis of the body. Similarly, and evident from theside view of FIG. 1A, the foot portion 150 is also offset from alongitudinal axis of the body. By having each of the head portion andfoot portion offset to the same side of the body, and desirably whereinthe head portion is orientated above the foot portion the user oroperator of the device is assisted in identification of the location ofthe foot portion within the defect when the foot portion is not visibleto an operator—such as when the foot portion is located through a defectand within the abdominal cavity—such as shown in FIG. 2B.

In this arrangement of FIG. 2B it is clearly shown that each of the footportion and the head portion extend laterally away from the body portionand are offset an equal distance from the longitudinal axis of the bodyportion.

The side surface of the body facilitates a retraction of the abdominalwall or other fascial layer so as to provide surgical access. The devicetherefore provides a dual function as a retractor and a suture deliverydevice. This device may be provided singularly or as part of a suturedelivery kit comprising the device as described previously incombination with a suture driver arranged to deliver suture through theguide channel. With such a kit operable passage of the suture driverthrough the defect effects delivery of the suture though a first andsecond surface of the defect, as shown in FIG. 2B. When the suture iscoupled to an anchor, the kit may be used to deliver anchors through atleast a portion of a defect. Rotation of the device after delivery of afirst anchor at first side of the defect then allows the user tofacilitate delivery to a second side of the defect—FIG. 2B shows analready delivered anchor on the right hand side while the device is nowpresented and arranged to deliver the anchor to the left hand side.

In the alternative arrangement of FIG. 3 a guide 800 comprises a handleportion 805 and a guide portion 825 and a foot portion 850. The guideportion 825 is operably inserted into a defect defined within theabdominal wall. The guide portion comprises a tissue receiving cut-outportion 870 which is defined within the body of the device. First 811and second 815 surfaces extend inwardly from the outer surface of theguide to define the tissue receiving cut-out portion and are arrangedsuch that in use, abdominal wall tissue will invaginate into the tissuereceiving cut-out portion 870 and contact against the surfaces 811 and815. A guide channel 835 is defined within body of the guide and leadsto the tissue cut out portion. The guide channel 835 comprises aproximal opening 810 on a first, operably upper, surface 806 of theguide 800 and terminates from a distal opening 830. The distal opening830 is defined within the second surface 815, which operably defines anupper, surface 815 of the tissue receiving cut-out portion 870. Thetrajectory of the channel is configured such a driver delivered throughthe channel will intersects with and pass through tissue that may bedisposed within the cut-out portion.

A driver 500 and anchor 230 as previously described may be used todeliver an anchor through the tissue which is received within the tissuereceiving cut-out portion. Upon exiting the distal opening 830 andtravelling through the tissue, the orientation of the guide channel 835serves to direct the driver into a receiving chamber 855 defined withinthe first surface 811 of the tissue receiving cut-out portion. Thischamber 855 comprises inner surfaces which protect the inner organs frompuncture in a similar fashion to that described above with reference toFIGS. 1 and 2 .

In this embodiment the distal opening of the guide channel exits on aflat surface 815. An alternative arrangement would be that the surfacebelow the exit was undercut. In this arrangement, an undercut is definedbelow the distal opening 830 such that the surface 815 does not extendin a planar continuous fashion to the intersection with the surface 811.This could be advantageous in exaggerating the amount of tissue capturedby the suture. It will be appreciated that the length and diameter ofthe suture guide channel can be dimensioned to limit the depth to whichthe tip of the driver extends, which would prevent the driver tipimpacting against surfaces of the receiving chamber 855. Alternately thereceiving chamber could be filled with a silicone gel, which wouldprevent particulate liberated from the bottom surface of the receivingchamber from being drawn out of the receiving chamber.

Similarly to what was described with reference to FIGS. 1 and 2 thedevice of FIG. 3 is arranged such that the foot portion 850 is operablypresented first into a defect and engages with an inner surface of thedefect. The device is arranged such that it will contact with both theside wall 415 of the defect and the inner surface 410 of the abdominalwall 450, Refer to FIGS. 3C-3E. By contacting the abdominal wall in twoplanes, and receiving tissue into a tissue receiving portion defined inthe device between the two contacting surfaces, the present teachingadvantageously ensures that the suture driver 500 when passing throughthe suture driver guide channel 835 will exit the exit port 830 and passinto the surface of the defect within the landing zone. The surfacewithin which the exit port is defined is a second surface of the guidedevice and as shown in FIG. 3C operably abuts against the side wall ofthe defect. The foot portion defines a contact surface 105 that operablyabuts against the inner surface of the abdominal wall such the secondsurface is substantially perpendicular to the foot portion contactsurface.

Turning now to FIG. 4 , another exemplary suture delivery system inaccordance with the present teaching is shown. In this arrangement thesystem comprises multiple components which are then assembled to formthe final part, whereas the guides of FIGS. 1-3 are a single moldedpiece. With this arrangement surfaces of the receiving portion arereplaceable. Such an arrangement advantageously addresses potentialissues arising from multiple contacts with the same surface. As will beappreciated from the above, the present teaching uses the inner surfacesof the receiving portion as a stop against which the driver contactsduring use. A potential difficulty with having drivers repeatedlycontact the same surface, which can arise for example in scenarios wheremultiple anchors are being deployed, is that the sharp needle tip of thedriver may repeatedly contact the same portion of the guide and overtime it may begin to dislodge some of the guide material. In thisembodiment, the receiving portion is modified to incorporate a moreresilient material—in this example a stainless steel shim 710—as acontact surface which is located at the base of the receiving chamber1115. By providing a contact surface at the base of the receivingchamber, the driver needle portion is directed—by the orientation of theguide channel 1320 (refer to FIG. 5 ) into preferential contact with thecontact surface. The material that is used in fabricating the contactsurface is less likely to be damaged by the needle end portion and thusreduces the possibility of the integrity of the guide being compromisedwith reduced possibility of dislodged material being introduced into thebody cavity during use.

The contact surface may be retained within the receiving portion in anyone of a number of different ways. FIG. 4 shows a particularlyadvantageous arrangement whereby the stainless steel shim is retained bya shoulder 745 on the inner wall of the guide and a pillar 740. In thisembodiment the pillar 740 is shown as an elongation of a screw receivingpillar, but it will be acknowledged that these two adjoined pillarscould be formed as a single piece, that is if the screw position wasadjusted, or they could be two separate entities. To allow for assemblya cap 720 is provided, which can be screwed into position with the screwonce assembly is completed. It will further be appreciated by thoseskilled in the art that the same effect could be achieved a number ofways. For example, the cap 720 could be designed with clip features,such that the screw is not necessary to retain the cap. In anotherembodiment the side wall of the receiving portion could feature j shapedchannel into which a j-shaped shim is placed. Alternately, the u-shapedinner surface as per FIG. 2 could be modified at the top to add twobumps, which could be used to retain a u-shaped steel shim. Further, theshim could be biased, such that upon placement in the receiving portion,it exerts an outward force, which helps maintain its position.

Depending on the tolerances of the stainless steel shim 710 and its fitwithin the guide there may be an effective rattling of the component,which may be undesirable. Is such a scenario the bottom surface 745 ofthe receiving channel 1115 may be coated with a silicone fluid or thelike, which will retain the stainless steel shim due to surface tension.

An advantage of the stainless steel shim in the guide, is that when thedriver is passed through the guide and the sharp tip bottoms out on thestainless steel shim, an audible click is generated which will provideaudible feedback in addition to the tactile feedback that is alreadygenerated by the contact of the two elements. The user is then providedwith reassurance that the anchors have been successfully deliveredthrough the abdominal wall.

Another feature of the guide of FIG. 4 is the incorporation of a suturerelease slot 1060. This slot allows the suture to be released from theguide. In using the guide of FIG. 1 , once the first anchor isdelivered, the trailing suture remains in the guide channel until theguide is removed completely over the trailing suture. The advantage ofthe suture release slot 1060 is that once the anchor is delivered, thesuture can be pulled taut, and as the guide is pushed away from thetissue wall, the suture is released from the guide. The guide can thenbe rotated in situ for delivery of a second anchor on the opposing wall,without having to remove the guide from the defect.

An alternate embodiment would provide an additional slot 1900 in thefoot portion of the guide. Such an arrangement is shown in FIG. 10E andillustrates how such a slot 1900 could be used to receive a suture 610.A larger diameter opening 1910 is provided at the base of the slot. Thisopening 1910 would allow the suture 610 to pass freely when pulled fromeither side. A narrowing in the slot is provided by raised shoulders1905A and 1905B. Such a narrowing prevents the suture from beingaccidently released from the slot 1900 and allows the suture 610 to beeasily loaded, by laying it across the slot and pulling it in a downwarddirection, in a manner similar to securing using a cleat. Such anarrangement could be advantageously used to deliver suture to anintra-abdominal space. The user could then use a conventional suturepasser 2500 through the opening 1310 defining the entrance to the guidechannel 1320 (previously referred to in FIG. 5 ) to pick up the suturethat is located within the landing region. Such an arrangement isevident from inspection of FIG. 10A and advantageously provides a safemeans of creating a closed loop closure as the receiving chamber 1115 ofthe guide protects from over insertion of the suture passer.

To use the device of FIG. 10A with reference to FIG. 10B-FIG. 10D:

a. The user loads suture 610 onto the guide 1140.

b. The guide 1140 is then passed through a defect in the abdominal wall.

c. The suture grasper 2500 is passed through the guide and ismanipulated to grasp the suture 610.

d. Once the suture is held in the jaws 2600 of the grasper, it isretracted until the suture exits the opening 1310.

e. As the suture loop 615, is drawn further outside the body, the suturewould pull completely through the opening.

f. The guide could then be removed from the defect and be reloaded withthe suture.

g. The guide can them be repositioned in the defect on the oppositeside, and step a-f be repeated.

h. The guide is removed from the defect leaving a loop of suture in thedefect, which can be tied with an appropriate surgical knot.

One end of the suture, 611 for example could be presented with a stopperknot, which would prevent the suture pulling through the opening 1910 onthe guide, which would ensure that the suture pulls free from one sideonly. An alternative arrangement would be to provide the opening 1910without suture. This arrangement would be more secure in terms ofpreventing the suture from pulling out through the slot, but would bemore time consuming in terms of loading.

FIG. 5 illustrates another feature of the guide of FIG. 4 whereby theneedle guide channel 835 features an internal ramp 755. The benefit ofsuch a feature is that it effects a reduction in the clearance withinthe channel, when the driver is delivered through, which has the effectof giving a more consistent bite through the tissue. This is an effectcaused by the reduced diameter of the driver shaft 510, as is seen inFIG. 5 . An alternative arrangement is shown in FIG. 6 where the guidechannel features a reduced diameter portion 760 proximal to the proximalopening of the needle guide channel. In using this guide, the anchorswould be loaded, firstly into the guide by pushing the proximal end ofthe anchor 235 into the guide exit 1330, i.e. in a direction opposite tothat in which they will ultimately be delivered into the tissue, andthen using the suture (not shown) to pull the anchor into the step 765.The driver is then presented through the opening 1310 of the guide andas it passes through, the anchor is picked up by the stepdown portion ofthe driver.

Further examples of reloading anchors onto drivers are shown in FIGS. 7and 8 , which may be used in combination with the guides of FIGS. 1-5 .There is shown herein a reloader tool 900 which comprises a proximalopening 910, an anchor receiving portion 920 and a suture cleat 940. Theanchor is loaded into the anchor receiving portion, and the trailingsuture is secured in the cleat 940. The driver 500 is passed through theproximal opening. The internal geometry (not shown) serves to align thedriver such that the stepdown portion 515 will be centered on the anchorand pick it up, as it is advanced through the reloader tool 900. Thedistal end of the anchor receiving portion 920 features a ramp 925. Asthe driver advances this ramp provides resistance against forward motionof the anchor, allowing it to be picked up by the driver, and secondlyas the driver is advanced the misalignment of the ramp forces the driverinto the exit slot 930. The suture cleat is designed such that theinside of the cleat is a circular profile and that as the anchor isadvanced, the suture trails from the cleat.

The device 950 of FIG. 8 comprises an obturator 980 and a guide 950. Theobturator 980, which could be spring-loaded to facilitate a Veressneedle type protected delivery—comprises a proximal handle 990 and ashaft 985 which are joined. The handle 990 allows the user to handle theobturator and remove it from the guide portion. The guide 950 comprisesa proximal portion 959 joined to a shaft 960. The shaft 960 terminatesdistally in a sharp tip 970. When the obturator 980 is in place itserves to protect the sharp tip. The proximal portion 959 has a lead-in955 to a lumen disposed through the proximal portion 959, which furtherextends completely through the device via the shaft, through which ananchor 230, such as that shown in previous embodiments may beintroduced. The anchor can be pulled further into the lumen until thesuture is as distal as it can be in the slot 965. Finger grips 975 areprovided on the external surface of the proximal portion 959. These areillustrated as smooth, but could be textured to improve grip. The devicecould then be passed through an abdominal wall, or through a prostheticmaterial, such that the distal end is inside the abdominal space,interior to the inner abdominal wall or prosthetic material. The anchorcan then be delivered by passing the obturator back though the guide.The anchor is pushed distally through the guide, until it exits in theintra-abdominal space. The guide and obturator can then be retractedleaving the anchor in situ. The remaining anchor can then be used inconjunction with other such anchors to approximate tissue or prostheticmaterial.

Another example of use of a guide 1140 in accordance with the presentteaching is illustrated in FIG. 9 . The guide 1140 interacts with aprosthetic device 1500. The prosthetic device 1500 features an opening1530 on the abdominal wall engaging side 1510. The opening has a pair ofstraps 1540 and 1550 attached to the device 1500 and which can be usedto manipulate the prosthetic device 1500. The prosthetic device furthercomprises an organ contacting side 1520, which in combination with 1510defines an internal space in the device, which is accessed through theopening 1530. In use the distal portion of the guide 1150 is insertedinto the prosthetic device through the opening 1530 guide. Anchors canthen be delivered through the guide 1140, entering through theprosthetic material on the abdominal engaging portion 1510. Thedelivered anchor(s) are then retained in the inner volume of theprosthetic device. This enables fixation of the prosthetic device insitu, whilst also allowing and facilitating closure of the defect.Whilst shown as having a solid geometrical form, it will be appreciatedthat the form of the prosthetic may vary and could equally be providedin a mesh form.

While all of the embodiments above illustrate a single delivery channel,it will be appreciated by those skill in the art, that a similar guidecould be provided featuring multiple delivery channels, to allow foranatomical differences, for example abdominal wall thickness in obeseand non-obese patients, wherein the angle of the guide channel is variedto achieve the desired outcome.

As detailed above, in accordance with aspects of the present teaching,the suture/anchor assembly may consist of a length of bioabsorbablesuture attached to bioabsorbable anchor, provided for example in theform of a length of bioabsorbable tubing or molded geometry, and in oneembodiment configured such that the assembly is t-shaped. The suture maybe a braided or monofilament suture made from any application specificbioabsorbable or non-absorbable polymers. For fascial layer closure aUSP size 0 suture is preferred. This material is ideally suited to anapplication where the suture maintains approximately 50% of its strengthafter two weeks. However it will be appreciated that the suture materialmay be changed depending on strength or mass loss requirements of thespecific application.

While preferred arrangements have been described in an effort to assistin an understanding of the teaching of the present invention it will beappreciated that it is not intended to limit the present teaching tothat described and modifications can be made without departing from thescope of the invention.

It will be appreciated that the exemplary arrangements or examples ofdevices have been described with reference to the Figures attachedhereto. Where a feature or element is described with reference to oneFigure, it will be understood that the feature or element could be usedwith or interchanged for features or elements described with referenceto another Figure or example. The person of skill in the art, whenreviewing the present teaching, will understand that it is not intendedto limit the present teaching to the specifics of the illustratedexemplary arrangements as modifications can be made without departingfrom the scope of the present teaching.

The words comprises/comprising when used in this specification are tospecify the presence of stated features, integers, steps or componentsbut does not preclude the presence or addition of one or more otherfeatures, integers, steps, components or groups thereof

What is claimed is:
 1. A laparoscopic surgical device comprising: a headportion; a body portion; and a foot portion, wherein the suture deliverydevice being configured such that the foot portion is operably presentedfirst into a defect and to engage with an inner surface of the defect,wherein the body portion comprises a suture driver guide channel havingan entry port defined in a first surface of the body portion and an exitport defined in a second surface of the body portion, wherein the footportion defines a landing zone at the exit port within which at least aportion of a surface of the defect is operably received such that asuture driver passing through the suture driver guide channel exits theexit port and passes through the surface of the defect within thelanding zone, wherein the foot portion defines a volume having an openmouth, the landing zone being accessed through the open mouth, whereinthe second surface operably abuts against a side wall of the defect andthe foot portion comprises a contact surface that operably abuts againstan inner surface of an abdominal wall, the second surface configured tobe substantially perpendicular to the foot portion contact surface whenoperably presented into the defect, and wherein the body portioncomprises a suture release slot extending along a length of the suturedriver guide channel, the suture release slot having a diameter smallerthan the diameter of the suture driver guide channel.
 2. Thelaparoscopic surgical device of claim 1, wherein the foot portioncontact surface and the second surface of the body portion areorientated substantially 80 to 110 degrees relative to one another. 3.The laparoscopic surgical device of claim 2, wherein the foot portioncontact surface provides an abutment surface defining a limit of travelof the suture driver passing through the suture driver guide channel. 4.The laparoscopic surgical device of claim 1, wherein the volume is aclosed volume.
 5. The laparoscopic surgical device of claim 1 whereinthe foot portion comprises a lip, the lip defining an engagement surfacefor contacting with and gripping against the inner surface of thedefect.
 6. The laparoscopic surgical device of claim 4, configured suchthat on gripping against the inner surface of the defect, the device isconfigured to receive, into the open mouth of the foot portion, at leasta portion of the defect.
 7. The laparoscopic surgical device of claim 1,wherein the suture driver guide channel is angularly orientated relativeto the open mouth of the foot portion such that operably, on receipt ofat least a portion of the defect into the landing zone, the suturedriver passing through the suture driver guide channel can pass throughfirst and second surfaces of the defect prior to contact with the footportion contact surface.
 8. The laparoscopic surgical device of claim 1,wherein the diameter of the suture release slot is about 0.5 to 1.5 mm.9. The laparoscopic surgical device of claim 1, wherein the suturedelivery device comprises a plurality of suture driver guide channels.10. The laparoscopic surgical device of claim 1, wherein the bodyportion defines an undercut below the exit port.
 11. The laparoscopicsurgical device of claim 1, wherein the suture driver guide channelcomprises a ramp.
 12. The laparoscopic surgical device of claim 1,wherein the landing zone comprises the contact surface against which thesuture driver operably contacts.
 13. The laparoscopic surgical device ofclaim 12, wherein the contact surface of the landing zone provides astop configured to limit further introduction of the suture driverthrough the suture delivery device.
 14. The laparoscopic surgical deviceof claim 12, wherein the contact surface of the landing zone comprises astainless steel shim which operably provides auditory and tactilefeedback.
 15. The laparoscopic surgical device of claim 1, wherein thesuture delivery device is configured for delivery of anchors, the suturedelivery device comprising at least one anchor preloaded in the suturedriver guide channel.
 16. The laparoscopic surgical device of claim 1,wherein the foot portion comprises a suture retention feature to retaina suture of the plurality of sutures during a delivery of the suturedelivery device into the defect, the suture delivery device beingconfigured to operably engage with a suture grasper which on receiptthrough the suture driver guide channel effects release of a retainedsuture from the suture retention feature.
 17. The laparoscopic surgicaldevice of claim 1, wherein the foot portion comprises an anchoringfeature.
 18. The laparoscopic surgical device of claim 1, wherein theexit port is located above the mouth.
 19. The laparoscopic surgicaldevice of a claim 1, wherein the body comprises an access channel orslot to along the length of the guide channel.
 20. The laparoscopicsurgical device of claim 19, wherein the slot has a diameter smallerthan the diameter of the guide channel.